Quintessence International, 02/1993

This paper is a clinical report demonstrating reattachment of a fractured incisor fragement. The fragment was replaced without the use of a filled composite resin, because the fracture had little splintering of the edges of the opposing pieces. Frank pulpal expsoure was treated by an acid-etching procedure, wet bonding and surface disinfection prior to sealing of the wound site. At 1 year, the tooth is vital and has remained totally asymptomatic.

To repair a coronal fracture with invasion of the biologic width, flap surgery with osteotomy and osteoplasty localized on the fractured tooth was performed, and the crown was reattached to the tooth remnant with a composite resin system. Results after 6 years revealed optimal periodontal health and reasonable esthetics.

An increased emphasis on the preservation of tooth structure has led to alternative cavity designs for early proximal caries. The tunnel restoration (which preserves the marginal ridge) and a conservative Class II composite resin restoration were compared in vitro for effects on tooth strength with nondestructive and destructive tests. The tunnel restoration, which is generally thought to be the more conservative of the two techniques, was actually more damaging, as shown by the stiffness, load at fracture, an d proximity to the pulp.

The main advantages of glass-ionomer cement are its ionic exchange with dentin and enamel and its continuous fluoride release, which acts as an effective anticariogenic agent. The new dual-curing (light-activated) cements have enhanced physical properties and excellent esthetics, so the situations in which they can be placed as a complete restoration are greatly increased. If the occlusal load is too great to use glass-ionomer cement alone, the dual-curing cements are ideal for the lamination technique, in which the cement is used as a dentinal substitute and is covered with composite resin. This paper discusses the clinical placement techniques required to ensure success with either technqiue.

Clinical experiences with light-hardened glass-ionomer-resin restorative cement indicate that it has improved properties compared to self-hardening glass-ionomer cements. Wear resistance and other material strengths are improved so that the material can be considered for conservative Class I restorations in permanent teeth. This article details occlusal restoration of a permenant molar with one light-hardened glass-ionomer-resin cement and discusses the potential for such restorations.

In vitro tests and a clinical examination of 51 patients who were treated over a period of 12 years have demonstrated that a composite resin core that is surrounded by a gold crown may provide the same function and strength as a conventional gold core. However, the method demands a thorough knowledge of the materials and a careful and detailed technique. The importance of an initially effective dentinal bond to the chosen hybrid composite resin is stressed. Zinc phosphate cements and the technique of cementing are also discussed. In most cases, a damaged root will have to be reinforced with a post, and the author recommends the use of a threaded titanium post that fits well and is bound to the root with a so-called passive cementation technqiue. The author has also had positive experiences with composite resin crowns, which can be expected to have a functional life of at least 10 years.

Nine clinical centers using the Branemark System participate in a prospective study of 159 partially edentulous patients between 18 and 70 years of age. Clinical parameters evaluated were Plaque Index, gingivitis, pocket depth, Bleeding Index, tooth mobility, prosthesis stability, and stomatognathic function. Change in bone height around fixtures was measured radiographically. After 3 years, 460 loaded fixtures, supporting 174 prostheses in 139 patients, remain in the study. The complications, failures, and technical problems are presented. After 3 years of this 5-year study, results suggest that implant-based treatment of partially edentulous patients may achieve a success rate comparable to that obtained in edentulous patients.

The purpose of the study was to evaluate whether the clinical effectiveness of pit and fissure sealant was increased (as demonstrated by an increased retention rate) when a bonding agent was used prior to the placement of the sealant. Two pit and fissure sealants, Concise Light Cured White Sealant and Prisma Shield Light Cured Sealant, were placed in vivo with and without the use of the bonding agents, Scotchbond 2 and Prisma Universal Bond. After 2 years, 55% of the sample was available for recall. The retention rates for the sealants were 77% for Concise and Scotchbond 2, 84% for Concise with no bonding agent, 77% f or Prisma Shield with Universal Bond, and 77% for Prisma Shield with no bonding agent. Results of this study indicated that the use of a bonding agent prior to the application of a pit and fissure sealant does not increase the retention rate.

Because of the intimate relationship of the root canal system and the periodontium, developing endodontic and periodontal lesions may mimic each other in clinical and radiographic appearance. The etiology, diagnosis, treatment, and prognosis of endodontic and periodontal lesions will be discussed.

Removal of bacterial plaque is a prerequisite to the prevention and control of periodontal disease. In highly motivated patients, it is possible to control plaque successfully by mechanical means. Because most patients lack sufficient motivation and skill to perform effective plaque control on a regular basis, use of antimicrobial chemic al agents is essential to gingival health. In 1985, Plax, a prebrushing oral rinse, was introduced. The manufacturer claims that the solution acts as a detergent that removes some bacterial plaque and loosens the remainder for easy removal by toothbrushing. A review of current dental research related to this claim is presented. The data provided do not support the use of Plax dental rinse as part of an oral hygiene program.